Treatment options for cervical dysplasia of the first degree during pregnancy

The structure of the cervix

The presence of dysplasia, detected during the pregnancy of a woman, will not affect the course of pregnancy or the health of the baby. If the likelihood of carrying a healthy child is established, it is not worth doing an operation to remove dysplasia, there is a high possibility of infection of the fetus, miscarriages, and the risk of intrauterine death of the fetus.
An important point during pregnancy is to conduct a cytological examination on time and, based on the results, discuss further treatment with your doctor. With a positive picture, one should not agree to a colposcopy, acetic acid is used in the study, unnecessary intervention in the body of a pregnant woman is at least inappropriate. It is better to refuse a biopsy, the procedure is carried out in case of urgent need.

female dysplasia

Treatment of dysplasia is desirable to carry out before pregnancy, in severe cases of the disease, part of the cervix is removed. For the conception and bearing of a child, the fact does not play a role. Childbirth proceeds naturally with any degree of dysplasia, in the absence of other contraindications.

Dysplasia during pregnancy, detected in the cervix, must be cured on time, preventing the chance of degenerating into a malignant tumor. Dysplasia is a change in the cells of the structure of the epithelium, the layer that forms the cervix. Three degrees are known. Mild degree - easy to treat, but you should not delay the process.

To have an idea about the disease, you need to know what the cervix is, what tissues it consists of. The cervix is made up of three types of tissue:

Epithelial.
Muscular.
Connective.

Epithelial tissue has a heterogeneous structure. Cylindrical cells are located in 1 layer, cover the uterine cavity and cervix, they have a rectangular structure. The vagina is covered in several layers by a squamous epithelium in the form of flattened cells. Epithelial cells are formed on a thin membrane, which is the basis and has a collagen composition.

The complex structure of the uterus leads to pathological processes that are associated with changes in the cellular structure. These diseases include erosion, dysplasia and uterine cancer.

Planning pregnancy with dysplasia

Should a woman plan a pregnancy with cervical dysplasia, only a doctor will determine. At the same time, attention should be paid to how gestation can affect the development of the disease. During pregnancy, hormonal changes occur. This can lead to abnormal development of epithelial cells.
But most often this is possible at a late stage of pathology. Therefore, in most cases, doctors allow women to become pregnant with mild to moderate cervical dysplasia. In addition, the disease may not progress for a long time, so it does not interfere with the bearing of the child.

Planning for pregnancy must begin with a diagnosis of the body.

If dysplasia is confirmed, then it is advisable to first cure the disease in order to avoid possible progression. You also need to get rid of concomitant ailments and hormonal imbalances.

Characteristics of the disease

Dysplasia is a reversible pathological process that occurs in the mucous tissues of the cervix. Under the influence of the disease, the structure of cells changes. So-called atypical cells appear in the epithelium, they may have an irregular structure of the nucleus or be multinucleated, and the appearance of irregularly shaped cells is also observed.

At the initial stage of the disease, one third of the thickness of the epithelium suffers. As the formation deepens, the stage of the disease increases. The deeper the tumor takes root, the more difficult it is to cure the disease. At the last stage, the pathology affects the entire epithelial layer. That is why the disease should be diagnosed and treated in a timely manner.

In modern medicine, the most common term is cervical intraepithelial neoplasia, or CIN for short. The stages of the disease are divided into CIN 1, CIN 2, CIN 3. Dysplasia is often called erosion, this is not entirely true, the etiology of these two ailments is different. Erosion develops as a result of mechanical action, dysplasia is formed as a result of changes in the cellular structure of mucous tissues.

More about dysplasia

Of all parts of the reproductive system, the cervix is the most susceptible to changes. After all, it connects the vagina and the organ itself.

This condition is called dysplasia and is characterized as a precancer. Another name for it is cervical intraepithelial neoplasia (CIN).

Changes in the epithelium during the disease are not irreversible. If dysplasia is detected at an early stage, it can be eliminated with medications. With the development of pathology, surgical treatment is indicated.

Methods of treatment

The causes of dysplasia in women aged 15 to 45 years, leading a vigorous sexual life, are elementary. Premature onset of sexual life, periodic active change of partners, possible infections and diseases obtained through sexual contact. This includes the lack of a healthy and sporty lifestyle, smoking.

Long-term use of hormonal oral contraceptives or COCs, possible hormonal disorders in the body of a woman of any childbearing age. The cause of the origin of dysplasia is the presence of the human papillomavirus, weakening of the immune system during pregnancy or stressful experiences.

Cervical dysplasia occurs without symptoms, but the appearance of discharge with a characteristic color should alert the woman. The only way to identify the disease is to undergo an annual examination by a gynecologist, passing a cytology test. During the planning period for pregnancy, it is necessary to first cure the disease, then prepare for happy motherhood.

The attending physician will prescribe medication, in parallel, prescribe therapy for concomitant infectious diseases. In the absence of positive dynamics in the treatment, the doctor will advise an operable intervention. There are a number of methods for removing the affected epithelial cells. For instance:

Cryodestruction - exposure to low temperatures strictly on the affected tissue areas.
Laser vaporization - laser removal of damaged cells, a side effect of the intervention is tissue burns.
Excision, or biopsy - removal of the affected area with an electric knife.
Electric excision, or cauterization by current, during the operation, rough scars are formed, which do not allow the cervix to be fully opened during delivery.
Radio wave coagulation using high frequency current.
Argon plasma coagulation, a non-contact method of tissue removal, a clear effect of argon on the depth of the focus. The method does not leave scars on the fabric.
Amputation of the cervix. The operation is possible in two ways: knife or ultrasonic.

During pregnancy, it is better to refuse treatment and return to the disease after the birth of the long-awaited miracle.

The operation during the planning period of the child will reduce the risk of deviations during pregnancy. After 2-3 months after the operation, it is permissible to try to get pregnant, the attending physician is called upon to monitor the condition of the cervix.

Cervical dysplasia shows a reversible process, it is important to monitor your health and seek medical help in time. A woman's health is important for the future of children.

The functioning of the placenta in a pregnant woman can fail. With a thorough clinical examination, histological examination, it becomes possible to identify the formation of complications in the mother, perinatal abnormalities in the fetus. The state of the placenta in pregnant women with forms of mesenchymal dysplasia is characterized by immaturity of the villi, signs of infection of the placenta in pregnant women, combined with low placenta previa in the uterine cavity. The consequence of a violation of the structure of the placenta is the insufficient development of the fetus, including slow growth.

Violations of the structure of the placenta

The causes of mesenchymal placental dysplasia are not fully understood, most practitioners assume the presence of congenital pathologies of the mother. Connective tissue dysplasia found in the future father can affect the development of the joint fetus. When an egg is fertilized by a sperm with dysplasia pathology, part of the DNA is transferred to the unborn child, respectively, diseases are inherited.

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Doctors are still arguing about the need to treat grade 1 dysplasia. Some insist on drug treatment, others argue that you just need to observe the development of pathology.

Operation types

Starting with grade 2, there is no difference of opinion regarding the treatment of the disease in the medical community. The only effective method is surgery.

The operation is assigned to the first phase of the monthly cycle. The doctor selects the method of surgical treatment individually for each patient, taking into account the results of her tests.

Cervical conization is the most common way to get rid of dysplasia. It is used for both diagnostic and therapeutic purposes. Previously, conization was done with a scalpel, but due to the high traumatism, a knife is almost never used today. It was replaced by a laser and Surgitron radio wave devices.

Surgeons resort to a scalpel only in those cases when it is required to obtain good material for histological examination. The laser severely damages the cells, and the Surgitron loop completely vaporizes them. Therefore, completely from the use of a scalpel, doctors can not.

Also, methods of electrocoagulation and cryodestruction are used to treat dysplasia. In the first case, the surgeon destroys the cells that have undergone a change with an electric current, and in the second, he freezes them. After freezing, the cells die and are excreted from the body.

After electrocoagulation, scars may remain, so for women planning to become pregnant, the cryodestruction method is more suitable. After it, there are no scars.

Medications are prescribed only simultaneously with the operation. The goal of drug treatment is to increase immunity and fight viruses. For this purpose, patients are prescribed:

Immunostimulants. These include: Isoprinosine, Prodigiosan, Timalin, Molgramostin, Splenin, etc.
Vitamin A, folic acid, selenium.

Also, dysplasia can be treated with alternative methods, but such treatment should be considered as an auxiliary.

Dysplasia is dangerous primarily by the likelihood of degeneration into cancer. To reduce the risk of such a development of events and reduce the likelihood of relapse, doctors prescribe a special diet for women.

The patient is forced to exclude from the diet:

Smoked products.
Alcohol.
Spicy food.
Confectionery.

To increase the level of folic acid in the daily menu, you need to add bananas, cabbage and buckwheat. Natural vitamins are easiest to get from fresh fruits.

A woman is advised to refuse to eat fast food and various semi-finished products, drink enough water.

The prognosis after treatment of dysplasia is positive. The vast majority of women after surgery retain the function of childbearing. And if you follow the doctor's recommendations, the likelihood of a relapse is extremely small.

Treatment of pathology after childbirth

Some time after the birth of a child, a woman will need to undergo an examination of the genital organs again. After that, the doctor will prescribe the treatment of pathology. It can be carried out both medically and surgically.

At the first stage, therapy may not be prescribed at all. Most often, doctors recommend expectant management. You just need to see a gynecologist regularly.

In the second and third stages of the disease, the gynecologist may prescribe medication or surgery. It all depends on how the pathology proceeds, whether there are concomitant diseases.

When a papillomavirus is detected, therapy is needed to eliminate it. For this, antiviral drugs are prescribed. It is also required to take drugs that stimulate the patient's immune system, and drugs that restore the vaginal microflora.

Surgery involves the use of one of the following techniques:

Diathermocoagulation. It implies the destruction of affected tissues with the help of high-frequency electric current. The effectiveness of this method is weak, there is a possibility of complications, so it is rarely used.

Cryodestruction. In this case, the focus of the lesion is low temperature. For this, liquid nitrogen is used, under the influence of which tissues disintegrate. This method has fewer consequences, so it is suitable for women who plan to have more children in the future.

laser therapy. This operation involves the destruction of the affected cells under the influence of a laser. Therapy is more expensive because it is the safest method to eliminate dysplasia.

Radio wave treatment. This method consists in removing tissue using a radio wave. The technique is also safe, but very expensive, so it is used only in private clinics.

Cervical dysplasia during pregnancy does not in itself adversely affect the baby. But in case of progression, it can lead to complications that will create a danger to the bearing of the fetus. Therefore, a woman should plan pregnancy and get rid of health problems before conception.

In a healthy cervix, the layers of the epithelium go strictly one after another. If there is a violation in the sequence of layers, then this is considered a pathology. Cervical dysplasia is a chaotic arrangement of layers.

This disease is sometimes similar to erosion, but its difference is that erosion is the result of mechanical tissue damage, and dysplasia is a cellular disorder. Treatment and management of the disease differ significantly from each other. Basically, dysplasia is considered to be the initial stage of a malignant tumor, although this is not always the case. Timely detected disease leads to full recovery.

It has three manifestations:

light;
moderate;
heavy.

Not only treatment depends on the degree of pathology, but also the ability of a woman to have a child.

Mesenchymal placental dysplasia

During pregnancy, during a planned ultrasound examination, the ultrasound doctor is able to detect an enlarged placenta that does not correspond to the degree of development of the calendar or obstetric gestational age.

After receiving the results of the ultrasound examination, it is urgent to visit a doctor who observes the pregnancy. Perhaps the doctor will offer to take tests or conduct an additional examination. An enlarged placenta is dangerous for the fetus and is diagnosed as a disease - mesenchymal placental dysplasia.

The disease can be diagnosed with the help of ultrasound, cystic drift has similar signs. You will need to do a control ultrasound in two weeks and confirm or refute the presence of mesenchymal dysplasia syndrome. After confirming the syndrome, the pregnant woman is placed in a hospital, the woman has various threats and the degree of their development associated with an unfavorable course of pregnancy:

Natural termination of pregnancy or miscarriage can occur at any week of pregnancy, possibly in the early stages. A woman may not know about the pregnancy that has occurred, write off everything for a long delay in menstruation or an unusual malaise during its course, not knowing about the possibility of becoming pregnant.
Premature birth in the early weeks of pregnancy. Childbirth can begin from the 20th week of pregnancy, which carries strong risks for the health and life of the baby. As a rule, subject to a number of recommendations, bed rest, and the absence of stressful situations, it is possible to avoid this threat and bring the baby to 36 weeks.
early birth
Postpartum bleeding. May begin on the second day after birth. It will require urgent medical intervention, the adoption of emergency measures to restore the health of the puerperal.
Delayed development of the fetus, with this type of dysplasia, the nutrients received from the mother with the food consumed, vitamin complexes do not enter through the bloodstream of the placenta, the baby does not receive them.
Fetal hypoxia due to oxygen starvation. The lack of oxygen due to the enlarged placenta negatively affects the fetus, the child does not receive sufficient nutrition through the placenta for full growth.
Early rupture of amniotic fluid, as a result, artificial childbirth. With the flow of part of the amniotic fluid detected by ultrasound, there are small degrees of probability of maintaining the pregnancy. In the event that most or the mass of amniotic fluid flows out, labor should be stimulated with medication or an unscheduled caesarean section should be started, otherwise, after four hours, the child may die.
Preeclampsia. The complications of the course of pregnancy are manifested by high blood pressure, muscle cramps in the legs, loss of protein in the urine, swelling of the limbs or abdomen. It provokes high mortality among women in labor, high perinatal mortality among children.
placental insufficiency. A variety of complications during the course of pregnancy, in which a delay in the development of the fetus is formed.
Fading pregnancy in the first trimester. Diagnosed by ultrasound or fetal ECG.

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Scrupulous control of pregnancy, the general condition of the mother, control of fetal development become the main points after a thorough study of the analyzes of the pregnant woman in order to diagnose various pathologies early and plan the method of delivery in advance. In the presence of the disease, doctors often allow a natural birth, with stable indicators of the mother and fetus, constant monitoring of the cervix. Local anesthesia is used during childbirth.

Mesenchymal placental dysplasia is the growth of placental tissues that exceed the gestational age by several times. Such an anomaly will lead to impaired blood flow to the fetus, causing chronic fetal hypoxia. The disease is not treated.

With the birth of the child, the placenta will be removed, a new pregnancy passes without complications. In the case of a favorable outcome of delivery, the disease will not affect the child in any way, if connective tissue dysplasia is not transmitted at the gene level.

It is possible to plan a subsequent pregnancy in 1.5-2 years from the moment of successful delivery. Dysplasia during pregnancy is detected early and is carefully monitored throughout the gestation period.

Pregnancy after radio wave surgery.

Radio wave therapy involves cauterization of the affected area of the mucous membrane of the cervix with high-frequency radio radiation. Under the influence of this radiation, the local temperature in the surface layers of the mucosa rises. Atypical cells begin to release a large amount of energy, are destroyed and replaced by healthy tissue. As a result of the treatment of dysplasia with radio waves, scar tissue is not formed, and subsequent pregnancy proceeds without pathologies. Radio wave treatment is the fastest and painless method that is prescribed for nulliparous girls. Planning for pregnancy is possible in 2 to 3 weeks.

It should be remembered that infectious and inflammatory complications of cauterization can adversely affect pregnancy, regardless of the method.

To reduce the risk of infection and excessive scarring of the cervical mucosa, you should:

observe personal hygiene;
for discharge, use only pads, not tampons;
avoid hot baths, saunas;
avoid heavy physical labor and heavy lifting;
refrain from sexual activity for the period of complete healing of the mucous membrane of the cervix.

Symptoms of the disease

The second degree of this disease very rarely gives characteristic symptoms. Therefore, without a specific examination, it is very difficult to identify pathology. It is usually discovered by accident.

You can suspect the appearance of dysplasia by signs that appear after infection with HPV. We are talking about the appearance of genital warts on the external genitalia, in the vagina and anus.

Today, doctors must check for dysplasia in patients who seek help with various sexually transmitted infections.

If any infection is added to the existing dysplasia, then the patients experience non-specific symptoms that usually appear with colpitis and endocervicitis. These include:

Itching and burning in the vagina.
Discharge appears from the genitals. They may have an unusual color and an unpleasant odor.
Soreness during sexual intercourse or the use of hygiene products.

Vivid pain sensations with dysplasia are absent.

itching and burning in the external genital area;
mild pain in the lower abdomen;
mucous discharge, with an unpleasant odor, possibly interspersed with blood streaks;
pain during sexual contact;
the formation of papillomas and condylomas.

It is very important to detect the disease in time and start treatment. With a properly prescribed course of treatment, the disease rarely turns into an oncological form.

The course of childbirth

Cervical dysplasia and pregnancy are compatible, but a number of difficulties may arise during childbirth. With a severe degree of the disease, the birth process may begin prematurely. In some cases, pathology leads to forced abortion.

If the pathological process has spread to a large surface of the organ, its canal may be damaged during labor. When an organ is injured, bleeding begins. Too much bleeding can lead to the death of a woman in labor.

Dysplasia can also affect the baby negatively. If a child is born naturally, then when it passes through the damaged area, some of the pathological cells may end up in its mouth. As a result, papillomavirus can enter the infant's respiratory tract, which will adversely affect respiratory function. However, such a complication after childbirth is extremely rare - only 0.01% of children.

Diagnostics

Before starting treatment, you should undergo a complete diagnosis. The difficulty lies in the fact that at the initial stage the disease rarely makes itself felt, the symptoms are very weak or completely absent. Often a woman does not even suspect that pathological processes are taking place in her body. The diagnostic complex includes the following research methods:

First of all, you should consult a gynecologist. The specialist will conduct an examination using mirrors and identify pathological processes that manifest themselves externally: the appearance of spots on the mucous membrane, discoloration, dilation of blood vessels, various seals and other disorders characteristic of this type of disease.
Colposcopy allows you to examine the affected area in multiple magnification, at the same time, the necessary samples will be taken for further research.
Cytodiagnostics consists in identifying atypical cells.
Polymerase chain reaction is a diagnostic method aimed at detecting oncogenic papillomaviruses.
After cervicoscopy, the specialist receives pictures of the cervix obtained using a specialized camera.
Histological diagnosis consists in taking a piece of the affected tissue for analysis, this method is the most informative.

The data obtained in the course of complex diagnostics will allow not only to confirm the diagnosis, but also to determine the degree of its development. If left untreated, the disease will gradually develop into cancer. In addition, concomitant infections may join.

Pregnancy after diathermocoagulation.

The method of diathermocoagulation or electrocoagulation is the most traumatic method of cauterization of cervical dysplasia. It consists in cauterization of areas of the pathological focus with an electric current. Under the influence of current, the cells of the mucous layer die. The disadvantage of this method is that the electric current affects not only pre-tumor cells, but also healthy tissue. In this case, large mucosal defects are formed, which are replaced by scar tissue.

The appearance of extensive scars leads to:

violation of the menstrual cycle;
shortening of the cervical canal;
narrowing of the cervical canal;
loss of elasticity;
deformities of the cervical canal.

Violation of the menstrual cycle and shortening of the cervical canal can reduce the likelihood of conception or cause infertility. Any pathological changes in the channel adversely affect the course of pregnancy - the risk of abortion and premature birth increases. Due to the loss of elasticity during childbirth, the cervix can rupture. A narrowed or deformed cervical canal will interfere with the passage of the fetus through the birth canal, which can lead to fetal injury and rupture of the cervical tissue.

Therefore, cauterization by diathermocoagulation is not recommended for nulliparous women or those who plan to have children. But in the case of conception after cauterization of cervical dysplasia, a thorough gynecological examination with colposcopy and endoscopy is necessary to examine scars and identify risks. With serious changes in the mucous membrane of the cervix, in order to prevent its ruptures, most often, they resort to a caesarean section.

Surgical intervention

Surgery at the initial stage of the disease is extremely rare. If the pathology is actively developing, and the conservative method has not brought the desired result, the treatment is continued surgically. Among the popular surgical methods worth noting:

DEC (diatherocoagulation) is one of the traditional and inexpensive methods, it is used in almost all medical institutions. The impact on the pathological area is carried out with the help of an electric current. This method has many disadvantages, since the depth of exposure is difficult to control. As a result, you can remove excess tissue, or, conversely, an insufficient amount of tissue, in which case the disease will continue to develop. In addition, scars remain after such therapy.
Cryodestruction is based on exposure to liquid nitrogen. The scar formed on the cervix will have a looser structure. The depth of impact on the tissue in this case is also difficult to control.
laser treatment. Laser exposure is one of the modern methods, it is the most effective and safe method of therapy. The procedure is performed with a high and low intensity laser.

After surgery, a recovery period follows. At this time, you should follow the recommendations of doctors so that there are no complications. During the recovery period, sexual rest is necessary, which means that a woman should refrain from sexual intercourse. Also, you can not douching, you can not use hygienic tampons.

After four months, you should undergo a control examination. The doctor prescribes a cytological examination, which will need to be done annually.

If dysplasia is detected during pregnancy

Unfortunately, not all women are serious about planning conception. As a result, dysplasia of the uterine neck is diagnosed already during pregnancy. If this happens, there is no need to worry. It is not necessary to abandon the child and have an abortion.

However, the disease complicates the management of the patient. Indeed, in this case, you will need to constantly monitor the condition of the future mother, because there are certain risks.

Depending on the stage of development of the pathology, the consequences may be different:

First stage. It has a minimal chance of complications. The risk of degeneration into oncology is quite small. At this stage, the disease can be eliminated with the help of medicines approved for use during pregnancy.

There have even been cases when in women, due to hormonal changes during childbearing, cells are restored without medical intervention.

Second stage. In this case, tissue changes are the most serious, but pregnancy is allowed. Treatment can be carried out conservatively, but it does not always help. Surgical intervention during pregnancy is prohibited, it is carried out only after the birth of the child.

Third stage. This stage of development of dysplasia is dangerous for bearing a baby. The danger is that treatment must be carried out surgically, but this can only be done after childbirth . But during pregnancy, the disease can degenerate into oncology.

Types of pathology

Every year around the world, uterine dysplasia is detected in 30 million women. In most patients, the disease is at an early stage, but if left untreated, it progresses rapidly.

According to the WHO classification, dysplasia is a pathological condition that leads to the appearance in the thickness of the epithelial layer of cells with an atypical structure and a subsequent change in the supporting structures of the organ.

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The cervix has 2 sections:

The supravaginal region is located in the small pelvis.
Vaginal section. If necessary, the doctor can examine during a gynecological examination.

Inside the cervix is the cervical canal. It is lined with columnar epithelium. The vaginal part of the cervix is covered with squamous epithelium on the outside. Moreover, the latter partially enters the cavity of the external pharynx. There it borders on the columnar epithelium, forming the border of the transition, which physicians call the transformation zone. The vast majority of dysplasia develops in this zone.

The squamous stratified epithelium covering the outer part of the uterine vagina consists of 3 layers:

Basal, or basic. It lies on the stroma and is separated from it by a thin layer of connective tissue. The cells of this layer are the youngest. They have large nuclei.
intermediate layer.
Surface. This layer extends into the cavity of the cervical canal.

It should be noted that as we approach the surface, the cells of the layers have more and more differences from each other. This is clearly seen in the study of the material taken during the biopsy. Normally, cells correspond to their layer. With dysplasia, cells shift relative to their layers. Moreover, irregularly shaped cellular structures are visible. The nuclei in them are shapeless, devoid of clear boundaries.

Depending on the layer in which doctors detect cellular structures with a pathological structure, the following stages of pathology development are distinguished:

First stage. It is characterized by the appearance of irregular cells in a third of the thickness of the epithelial layer, if we count from the membrane between the stroma and the basal layer.
Second stage. The pathological process captures two-thirds of the epithelial layer.
Third stage. Atypical cells are detected in the entire thickness of the stratified epithelium.

Cervical dysplasia is also divided into degrees according to the severity of tissue damage. According to the WHO classification, the following main forms of pathology are distinguished:

First degree. In the West, it is designated "CIN I". The intermediate and superficial layers are not involved in the pathological process.
Second degree or "CIN II". Changes in cells are detected in the third part of the stratified epithelium.
Third degree. Designated "CIN III". Pathological changes are found in most of the epithelium. Moreover, the pathology captures part of the basement membrane and migrates into the cervical canal.

What is a cervical smear for oncopathology?

For example, the mucous tissues of the vagina must have a number of properties: a certain size of the cell nuclei of epithelial cells, a certain number of layers in the mucous tissue, gradually, as maturing cells move from the basal layer to the outer, they flatten, the size of the nucleus and the composition of intracellular organelles change.

Dysplasia is a violation of the cellular and tissue structure of a certain tissue. Cell contacts between cells also have a number of properties that can change with dysplasia.

A smear from the cervix for oncopathology is an analysis performed when cancer is suspected, or for the early detection of diseases that can lead to the development of malignant tumors in the future.

In this case, the material taken from the internal genital organs (usually from the cervix) is examined.

A smear from the cervix is obtained during a routine gynecological examination using special brushes and spatulas. The doctor can make several samples for research - on one glass there will be a smear from the unchanged part of the cervix, and on the second - material from the site of the greatest lesion.

Subsequently, the smears are dried on glass slides; in the laboratory, they are stained with various dyes and examined under a microscope.

The study of smears allows you to identify precancerous diseases at the earliest, treatable stages. What can a laboratory technician see when examining a smear:

Unaltered cells are the norm;
Signs of inflammation with the presence of altered cells are a variant of the norm, but anti-inflammatory treatment is required;
Cells with altered nuclei in structure and shape - a clarifying study is required;
Single cells with signs of degeneration (enlarged nuclei; discoloration or uneven distribution of the dye inside the cells) is a sign of dysplasia, i.e. precancerous disease;
A large number of cells with an atypical structure is a sign of cancer.

In addition, the smear is examined for signs of the human papillomavirus - it is he who in 95% of cases is the cause of precancerous diseases of the cervix.

The main sign of the presence of the papillomavirus is the detection of cells with a large light gap around the nucleus, as well as cells with a greatly enlarged nucleus and an altered structure of the nucleus itself.

Recurrence of cervical dysplasia most often occurs due to activation

Prevention

In order to avoid relapses, a number of rules must be observed. First of all, proper nutrition should be organized, it should include vitamins, mainly vitamins A and a group of B vitamins.

timely detection and treatment of infectious and non-communicable diseases;
you should stop smoking;
it is necessary to use barrier contraceptives;
exclude promiscuity;
monitor your health and regularly undergo examinations by a gynecologist.

Accurate adherence to preventive measures will protect the body from the disease, and with an already existing diagnosis, it will speed up recovery.

Cervical dysplasia is a serious disease, the treatment of which should not be delayed. The disease proceeds in three stages, after which the risk of cancer cells is high. Thus, the disease can turn into a malignant tumor. The prognosis of the disease at the initial stage is favorable.

Is it possible to endure and give birth to a child with dysplasia

With dysplasia of the 1st degree, the process of bearing a child does not differ from the usual one. A woman is recommended to visit a doctor once or twice a week.

The doctor should monitor the progression of the disease. If at the beginning of pregnancy there is a high probability of complications, the gynecologist may prescribe an abortion.

In the last months of pregnancy, if the dysplasia has not healed itself, the patient should go to the hospital for preservation.

In the case of a disease of the 2nd degree, the process of bearing the fetus proceeds without complications. However, a woman should be regularly examined by a doctor, and once every 2 weeks, take tests (Pap smear, biopsy, ultrasound) to make sure that atypical cells do not degenerate into cancer.

If a woman becomes pregnant with grade 3 dysplasia, abortive intervention is required. It is not recommended to carry the fetus until the disease is completely cured. Already after the pathology, you can become pregnant, but all 9 months should be kept.

Causes of the disease

The main cause of the appearance of pathology is considered to be the infection of a woman with certain strains of the human papillomavirus. According to statistics, with dysplasia of the second degree of the cervix, in 98% of cases, this virus is detected in patients.

Doctors believe that in the first 2 years of sexual activity, more than 80% of girls become infected with HPV.

It should be said right away that not every case of infection develops dysplasia. What causes this pathology? requires the presence of one or more provoking factors. These include:

Weakening of local immunity. This is expressed in a decrease in some immunoglobulins and an increase in others in the mucous membrane of the cervical canal.
Endocrine diseases.
Hormonal disorders associated with pregnancy or abortion, as well as with the use of hormonal drugs. A change in the hormonal balance provokes the appearance of aggressive variants of estradiol, which cause the degeneration of cells containing the human papillomavirus.
Heredity. If there were cases of dysplasia in the family, then the probability of getting sick increases one and a half times.
Chronic inflammatory processes affecting the genitals. These include: colpitis, trichomoniasis, cytomegalovirus, herpes.
Condylomas on the labia and in the vagina.
Early onset of sexual activity (before 15 years).
Frequent childbirth.
Injury received during childbirth.
Instrumental research and repeated abortions.
Several interruptions of pregnancy by artificial methods.
Sex with a man who had cancer of the glans penis.
Folic acid deficiency.
Alcohol abuse.
Smoking.

If these risk factors are absent, then the woman's body gets rid of the virus on its own within a few months. Moreover, in young girls, first-degree dysplasia, after the elimination of the virus, degrades in half of the identified cases of the disease. That is, the disease simply passes.

Pregnancy after laser vaporization.

Laser therapy is an effective method of cauterization of cervical dysplasia, which is used in nulliparous girls and those who are planning a second pregnancy. Under the action of laser radiation, only atypical cells are destroyed without harm to healthy tissue. Precancerous cells are evaporated and replaced by healthy epithelium. Due to the fact that the dose of laser radiation can be controlled, damage to the cervical mucosa is minimal and no scarring is formed. The period of re-epithelialization of the mucosa and complete recovery is short ( up to 2-4 weeks

). Laser coagulation has no negative impact on the ability to conceive, pregnancy and childbirth. And a month after treatment, pregnancy planning is possible.

Diagnostic methods

Doctors resort to in-depth diagnostics after, during an examination of a woman in a gynecological chair, they reveal an unusual shine on the surface of the mucous membrane of the cervix and spots. The following methods are used in the study:

Colposcopy. The cervix of the uterus is treated with a solution of molecular iodine . The affected areas of the mucosa do not change color and become clearly visible.
Pap test. The gynecologist makes a smear, and then conducts a cytological examination. Dysplasia is diagnosed by identifying cells with shrunken nuclei.
Biopsy. Histological examination of the material taken allows doctors to determine the degree of the disease.
PCR analysis. It is carried out to determine the oncogenic strain of human papillomavirus and assess its concentration in the blood.

When it is required to obtain the most accurate results on the virus, then the analysis is carried out according to the HCII method. Based on the results obtained, treatment is prescribed.

Pregnancy after cryodestruction.

The method of cryodestruction destroys the affected areas with liquid nitrogen or carbon dioxide. Atypical cells are frozen under the influence of low temperatures ( up to minus 150 - 170 degrees

). Dead precancerous cells are rejected and replaced by new healthy epitheliocytes (
epithelial cells of the mucosa
). Complete epithelialization is observed after 4-6 weeks. With this procedure, scars are not formed, the cervix is \u200b\u200bnot deformed. Pregnancy after cauterization of dysplasia by cryomethod has practically no complications.

During the cryodestruction procedure, it is quite difficult to control the volume of tissue being frozen. Therefore, the period of healing of the postoperative wound is longer, and it takes about 2-3 months to fully restore the reproductive function of a woman. It should not be used in women who plan to become pregnant as soon as possible.

What impact does it have?

What to do if dysplasia and pregnancy are diagnosed at the same time?

If a woman is diagnosed with grade 1 dysplasia, her pregnancy will proceed as usual, but a visit to the doctor should be as often as possible.

At grade 2, gestation is also almost never complicated . But in this case, it is very important to take tests as often as possible to control atypical cells - it is necessary to ensure that they do not transform into malignant ones.

If, in the presence of pregnancy, the doctor has diagnosed "dysplasia of the 3rd degree", unfortunately, it is recommended to terminate the pregnancy . Pathology does not affect the process of bearing a baby, the only threat may be the addition of an inflammatory or infectious process to the pathology.

Dysplasia can affect childbirth . The fact is that this disease leads to a deterioration in the elasticity of the cervix, and during delivery it may not open in the right amount. This can cause tissue ruptures, and in severe cases, an emergency caesarean may be required.

Whether it is necessary to treat?

Treatment during pregnancy is carried out in two cases - if the disease was provoked by a virus, and if dysplasia developed against the background of hormonal disorders . In the first case, active antiviral therapy during childbearing is not prescribed, and preference is given to local agents.

As for the use of folk methods , they are permissible with the permission of the doctor .

The expectant mother should understand that not all folk recipes are absolutely safe, and that many of them are contraindicated while carrying a baby.

Clinical observation 2

Patient Sh., 32 years old. Pregnancy repeated, history of urgent spontaneous childbirth without complications. She was referred to the MONIIAG polyclinic with suspicion of partial hydatidiform mole. Ultrasound at 15 weeks revealed thickening of the placenta up to 32 mm, approximately 1/3 of the area of the placenta with an altered structure — multiple small hypo- and anechoic inclusions up to 3 mm in size (Fig. 1).

Markers of chromosomal abnormalities and fetal malformations were not identified. The hCG level is within normal limits. Conclusion ultrasound: pregnancy 15 weeks, partial hydatidiform mole. Given the absence of fetal anomalies, a decision was made to prolong the pregnancy. The course of pregnancy was complicated by intrauterine growth retardation.

Standard therapy with vasoactive drugs was carried out. She was delivered at 37 weeks' gestation, spontaneous delivery occurred, a girl was born weighing 2800 g, 46 cm tall, which corresponds to grade I fetal hypotrophy, with an Apgar score of 8-9 points. Blood loss during childbirth 350 ml. The postpartum period proceeded without complications.

Rice. 1. Patient Sh. Structural changes in the placenta.

a) 15 weeks pregnant.

b) 37 weeks of pregnancy.

Diagnosis of MDP was carried out by histological examination of the placenta.

Patient I., 29 years old. This is the second pregnancy. Screening ultrasound was not performed in the first trimester. According to the patient, during an ultrasound scan performed at 18 weeks of gestation, there were suspicions of a hydatidiform mole, and therefore she was consulted at the Russian Cancer Research Center. N.N. Blokhin. The presence of trophoblastic disease has not been confirmed. The level of β-hCG is within the normal range: 23,335 IU / l (10,000-35,000 IU / l).

In MONIIAG she was under observation from 20 weeks of gestation. Ultrasound data: the size of the fetus corresponds to 20 weeks of pregnancy. Malformations and signs of fetal hypotrophy were not found. The placenta is located on the anterior wall of the uterus, 145-147 mm in size, up to 50 mm thick. The structure of the placenta is changed, there are many rounded liquid inclusions of various diameters - from 4 to 12 mm with clear, even boundaries.

Rice. 2. Patient I. TIR. Diffuse thickening and multiple cystic inclusions in the placenta.

Rice. 3. Vascular tree in TIR. The architectonics of the basal and spiral arteries is not disturbed.

Rice. 4. Vascular tree in TIR. Dilated vessels of the stem villi.

During the second trimester, combined thrombophilia for the MTGFR gene and the Leiden factor was detected. The level of homocysteine is within the normal range. APS markers were not identified.

Ultrasound with a gestational age of 36-37 weeks: the size of the fetus corresponds to 36.6 weeks of pregnancy. Signs of malnutrition and fetal malformations were not found. Fetal-placental blood flow is not disturbed. The amount of amniotic fluid is within the normal range. The placenta is located on the anterior wall of the uterus, up to 78 mm thick, II degree of maturity.

Spontaneous delivery occurred at 38 weeks. A live full-term girl was born with a body weight of 2710 g, a height of 47 cm, which corresponds to grade I malnutrition, without visible malformations, with an Apgar score of 8 and 9 points. Blood loss during childbirth 300 ml. The postpartum period proceeded without complications.

Placenta weight 1498 g (median 445 g), dimensions 28 x 27 cm, with marginal attachment of the umbilical cord. Disc up to 7 cm thick, chorionic plate with convoluted, sharply plethoric vessels, large foci of subchorial fibrinoid. Maternal surface with impaired integrity, in the marginal sections of the cyst with transparent contents up to 1.5 cm in diameter.

Rice. 5. TIR, macroscopic picture.

a) Fragment of placental tissue with vesicular villi.

b) Large convoluted vessels surrounded by jelly-like material, cystic cavities, an abundance of fibrinoid.

Microscopic examination of the placenta reveals large stem villi with edematous, loose stroma, in places with the formation of cavities (Fig. 6). Vessels in the affected villi of different diameters, often intricately convoluted. Various vascular lesions are observed: obliterative angiopathy, thrombosis, often with organization, hemorrhagic endovasculitis.

Rice. 6. TIR, microscopic picture.

a) A sharp swelling of the stem villi with the formation of cavities. x200. Stained with hematoxylin and eosin.

b) Intermediate and terminal villi of the usual type next to the edematous stem villus. x100. Stained with hematoxylin and eosin.

c) Convoluted, dilated vessel of the stem villus. x200. Immunohistochemical reaction with anti-CD31 antibodies.

d) Edematous stem villi with formation of cavities; numerous vessels of different diameters are visible in the preserved stroma. x100. Immunohistochemical reaction with anti-CD31 antibodies.

From 25-26 weeks of gestation, intrauterine growth retardation of the fetus of the 1st degree, asymmetric type, was detected. Fetal-placental blood flow is not disturbed. Placenta "0" degree of maturity, 33 mm thick (greater than normal), with multiple cystic formations, covers the internal pharynx. When examining the level of hormones of the fetoplacental complex at 30 weeks of gestation, placental lactogen, progesterone, cortisol, and α-fetoprotein were within the normal range.

about 1/3 of the placenta along the left edge with structural changes: multiple fluid inclusions up to 4-5 mm in size, blood flow is determined, the architectonics of the vascular tree is not changed. Attachment of the umbilical cord to the unaltered part of the placenta. Conclusion: pregnancy 31 weeks. Head presentation. Syndrome of fetal growth retardation I degree. TIR. Moderate polyhydramnios (Fig. 7).

Rice. 7. Patient F. TIR. Cystic inclusions in the structure of the thickened placenta.

The course of pregnancy was complicated by the addition of moderate preeclampsia. Despite the ongoing therapy, there was an increase in the symptoms of preeclampsia, there were violations of fetal hemodynamics. With a gestational age of 36 weeks, the patient was delivered by caesarean section. A live premature girl with a body weight of 1950 g, a height of 44 cm was extracted, which corresponded to intrauterine growth retardation of the II degree, malnutrition of the II degree. Assessment of the state on the Apgar scale 7 and 8 points. The operation proceeded without technical difficulties. Blood loss was 800 ml.

The weight of the placenta is normal (409 g at a median of 408 g). Disc 5-7 cm thick, chorionic plate with convoluted, sharply plethoric vessels, large foci of subchorial fibrinoid. Maternal surface with intact integrity, in the marginal sections of the cyst with transparent contents up to 1.5 cm in diameter with changes in the villous tree and pronounced hemorheological changes - necrosis of large groups of villi and fibrin obliteration of at least 1/3 of the volume of the placental disc. Histological conclusion: TIR.

Patient O., 28 years old. She was referred to the MONIIAG polyclinic with suspicion of partial hydatidiform mole. In the study at MORIAH, the dimensions of the fetus correspond to 14-15 weeks of pregnancy, markers of chromosomal abnormalities and fetal malformations were not detected. The placenta is located on the anterior wall of the uterus 28 mm thick.

Massive structural changes in the placenta were revealed: multiple fluid inclusions of various diameters - from 4 to 12 mm, rounded, anechoic, with even clear contours. The blood flow in the myometrium is pronounced, in the structure of the placental tissue, multiple loci of blood flow, vessels of large diameter, the vascular tree, and the architectonics of the vessels are preserved. Fetal hemodynamics is not disturbed.

Conclusion: pregnancy 13-14 weeks. Structural changes in the placenta - TIR cannot be excluded. Differential diagnosis with hydatidiform mole after obtaining a blood test for β-hCG (Fig. 8, 9).

Rice. 8. Patient O. Structural changes in the placenta in MDP.

Rice. 9. Patient O. Vascular architectonics in MDP.

An increase in the level of β-hCG served as the basis for referring the patient for consultation to the center of trophoblastic disease, where she was observed up to 33 weeks, differential diagnosis was carried out between multiple chorionangiomas of the placenta and dystrophic changes in the placenta. Clear data on the presence of trophoblastic disease was not revealed, despite a significant increase in the level of β-hCG (103,000 units at a rate of up to 78,100 units).

Ultrasound performed at MONIIAG at 33 weeks: the size of the fetus corresponds to 31.2 weeks of pregnancy. Estimated weight 1800-1900. Anomalies of development were not revealed. The size and weight of the fetus correspond to the 25-50th percentile for this period, intrauterine growth retardation was not detected. Placenta on the anterior wall of the uterus with a thickness of 40 to 52 mm, III degree of maturity.

Features of the structure of the placenta: on the right side, the placenta is more echogenic, in the structure there are single anechoic areas of irregular shape, the blood flow is normal, the vascular architectonics is not changed, the blood flow in the spiral arteries is traced, the resistance index (IR) is 0.36, the systole-diastolic ratio (S/D) is 1 .57.

The ultrasound picture of this part of the placenta is not typical for hydatidiform mole, not typical for the III degree of maturity, has no signs of chorionangioma. The rest of the placenta is thickened, the structure is more typical for the III degree of maturity - the border of the cotyledons is determined, in the center of the cotyledon there is an anechoic zone with a hyperechoic annular area along the periphery.

The vascular architectonics is not changed, the blood flow in the spiral arteries can be traced, IR 0.31, S/D 1.45. Conclusion: pregnancy 33 weeks. Head presentation. Diffuse thickening of the placenta. Structural changes in the placenta are not typical for chorionangioma and do not allow differentiation between partial hydatidiform mole and mesenchymal dysplasia.

Symptoms of hip dysplasia

Hip dysplasia is manifested by the following disorders in the development of cartilage, bone and muscle tissue:

disproportionate articulating surfaces: flattening of the acetabulum, which takes an elliptical shape with a spherical shape of the femoral head;
stretching of the joint capsule;
underdevelopment of connections.

The first symptoms of hip dysplasia can be diagnosed even in the maternity hospital, before complaints from the baby's parents:

asymmetry of skin folds. The number of folds increases on one thigh, in the prone position on the stomach, the folds on one side are higher and deeper;
Marx-Ortolani slip syndrome: the head of the femur slips with a characteristic click when pressure is applied to the hip axis and the limbs are spread apart. During the period of increased muscle tone (starting from a week of age), the symptom disappears;
shortening of one leg compared to the other, which is determined by the height of the kneecaps: on the healthy side, the joint is located higher than the affected one;
limitation during hip abduction, it is possible to spread the limbs by no more than 60 ° (normally, the limbs bent at the knees are bred to the sides at an angle of 80–90 °). The symptom is reliable until an increase in the tone of muscle fibers, only in the first days of life.

The final formation of the joints is completed after the child begins to walk independently. With the progression of changes in the connective tissue components of the joint, signs of the late stages of hip dysplasia are distinguished:

late rising to the feet and late start of walking;
gait disturbances (toe-in walking, lameness, "duck walk", i.e. swaying from side to side);
complaints of pain, pain in the hip joint and back;
development of excessive lumbar lordosis;
fatigue, instability in the hip joint after exercise or long walking.

Simultaneously with the main signs, accompanying symptoms of dysplasia can be detected:

torticollis;
violation of the search and sucking reflex;
muscle atrophy in the affected area;
softness of the cranial bones;
decreased pulsation of the femoral artery from the affected joint;
valgus or varus planting of the foot.

Forms of hip dysplasia

Acetabular (congenital) form of dysplasia is a congenital anatomical abnormality due to the abnormal structure of the acetabulum. The pressure of the femoral head causes deformation, displacement and inversion of the joint of the limbus cartilage located along the edges of the acetabulum. The joint capsule is stretched, the acetabulum acquires an elliptical shape, cartilage ossification occurs, and the femoral head is displaced.
Epiphyseal (Mayer's dysplasia) - affects the proximal femoral region. There is stiffness of the joints, pathological disorders of the cervical-diaphyseal angle, its change in the direction of increase or decrease, while the occurrence of deformation of the limbs is possible.
Rotational dysplasia - deformities of the mutual localization of bones when viewed in a horizontal plane. A manifestation of rotational dysplasia is clubfoot.

Hip dysplasia can also be congenital or acquired (the first symptoms of joint dysplasia appear and increase after the first year of life).

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